Jennifer Keller

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

494793 Issued in NY

Practice address

1190 Arrowhead LN
Peconic, NY 11958-1602

Phone

(631) 680-2010

NPI assigned

Apr 30, 2012

Last updated

Apr 30, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Bukowitz Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335744000000",
    "number": "1578821385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 436",
            "city": "CUTCHOGUE",
            "state": "NY",
            "postal_code": "119350436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 ARROWHEAD LN",
            "city": "PECONIC",
            "state": "NY",
            "postal_code": "119581602",
            "telephone_number": "631-680-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NY",
            "license": "494793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BUKOWITZ",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Xavier Amador, PH.D.
• Karen Catapano, R.N.
• Karriann S Dengel
• Richard Alan Hall, DC
• Norma Jean Mehrman, M.A.,CCC-SLP
• Sarah Swist, M.S. CCC-SLP
• Steven Mark Sygman, D.C.
• Susan Vanderpool, R.N., L.C.S.W.-R
• Joanne Slocum Woodle, MD

• Physical Disabilities Residential Treatment Facility in Peconic, NY
• Providers in Peconic, NY by specialty
• Physical Disabilities Residential Treatment Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.